MEDICARE: BOLTON DRUG & JEWELRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	251756	OK

General Provider Information

NPI Number	:	1750470969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLTON DRUG & JEWELRY

Provider Business Mailing Address
First Line	:	#3 N DALTON
Second Line	:
City	:	VALLIANT
State	:	OK
Zip	:	74764
Country	:	US
Telephone Number	:	580-933-4214
Fax Number	:	580-933-7605

Provider Business Practice Location Address
First Line	:	#3 N DALTON
Second Line	:
City	:	VALLIANT
State	:	OK
Zip	:	74764
Country	:	US
Telephone Number	:	580-933-4214
Fax Number	:	580-933-7605

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY BOLTON
Credential	:
Telephone Number	:	580-933-4214

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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Directions to “BOLTON DRUG & JEWELRY ” Practice Location

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